Abstract
Introduction:Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome.Methods:A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed.Results:In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome.Conclusion:Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.
Highlights
Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life
‘Nutrition’ encompassed all components that can be affected by diet, including: weight, electrolytes, vitamins, minerals and overall gastrointestinal (GI) health, since these can all be affected by the food one eats
Based on the nutritional factor evaluated, the authors developed 4 categories to aid the collation of evidence: (1) weight, (2) malnutrition and electrolyte imbalance, (3) vitamins and minerals and (4) gastrointestinal (GI) health
Summary
Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Degenerative processes include cervical spondylosis, ossification of the posterior longitudinal ligament, (OPLL), ossification of the ligamentum flavum and degenerative disc disease.[1] DCM is the commonest cause of spinal cord impairment in adults worldwide.[2]. Surgical decompression is the mainstay of treatment and for most is able to halt disease progression and afford meaningful benefit.[3,4] since the regenerative capacity of the spinal cord is limited, there is often permanent neurological disability[5] and people living with DCM have amongst the poorest quality of life of any chronic disease.[6] offering treatment before there is permanent spinal cord damage should prevent this, but there are many uncertainties challenging such practice today
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